COMMISSION INCREASES HEARING COSTS

Regulation 67-614 contains a provision to discourage claimant's pursuing spurious claims and carriers raising spurious defenses by allowing the Commission to assess actual costs of a hearing if the Commission finds "...the hearing has been brought, prosecuted or defended on unreasonable grounds."  The new assessment for hearings docketed but no hearing conducted is $202.81.  For hearings conducted, the assessment is now $1,014.86.

SUPREME COURT RULES COMMISSION'S PROCESS FOR SETTING MAXIMUM FEES FOR AMBULATORY CENTERS DOES NOT VIOLATE APA OR CONSTITUTION

The Commission won a significant victory before the Supreme Court in a suit brought by several ambulatory centers who challenged the process the Commission used to set maximum fees.  In 2004, the Commission convened the Hospital Advisory Committee to establish a new schedule of maximum allowable payments for ambulatory services.  In 2006, the Committee recommended revisions to the existing schedules by limiting the maximum payment to 140 percent of what Medicare would pay.  The centers sued challenging the process by asserting they had a right to a "contested case" hearing on the issue under the Administrative Procedures Act (APA).  The Court disagreed and found the centers had no such right.  The centers also argued they had a property interest in the outcome of the new rates and that interest invoked the state's constitutional due process protections.  The changes required a new regulation necessitating a public hearing.  The Court again disagreed and held the centers were primarily concerned with receiving future income based on desired future work.  This did not establish a property right.  The Commission was therefore within Regulation 67-1304, and the process for setting maximum rates for ambulatory services passed constitutional muster.

 

South Carolina Case Law Update
Compiled by Associate Anne Marie Hempy

 

Claimant's Testimony about Future Plans Enough to Support Denial of Wage Loss Claim

Hutson v. S.C. State Ports Authority, Op. No. 4737 (S.C. Ct. App., filed September 8, 2010)

Claimant injured his back working as a crane operator. The treating physician released Claimant at MMI with 10% impairment to the whole person (spine). The treating physician released Claimant to medium-duty work with permanent restrictions of no lifting more than 25 pounds.  These restrictions prevented Claimant from working as a crane operator. Click here to read the full article. 

Claimant Fails to Prove Medical Problems Resulted from a Workplace Injury

Hargrove v. Carolina Orthopaedic Surgery Assoc., Op. No. 4695 (S.C. Ct. App., filed June 7, 2010)

Workers' Compensation benefits are medical treatment, temporary compensation and permanent disability provided to an employee who is injured during his or her employment. Employers who regularly employ more than four people within South Carolina are subject to the Workers' Compensation Act. That means, if an employee is injured during employment, he is entitled to workers' compensation benefits even if it is his fault or if it was a result of his own stupidity that caused the injury.

Work injuries that are not compensable are those in which the employee intentionally disregarded a safety rule, was intoxicated, involved ordinary wear and tear, or suicide. Assaults are not compensable when they result from purely personal transactions, and horseplay is only compensable for the victim but not the instigator.

Once the work injury occurs, the employee has to verbally give notice within 90 days of the injury.  It does not have to be in writing.  An employee's failure to give timely notice will normally result in denial of the claim unless the employee can show to the satisfaction of the Commission that the claimant has a reasonable excuse for not giving timely notice, and the employer has not been prejudiced by this delay.  Click here to read the full article.